Surveillance, Prevention and Surgical Treatments for Hepatocellular Carcinoma

Liver cancer is the second-leading cause of cancer death, representing roughly 9.1% of all cancer mortality. Of all primary cancers of the liver, hepatocellular carcinoma (HCC) accounts for roughly 85%. HCC has been increasing in the U.S. and other countries. In particular, HCC places a huge burden on the Chinese population, as China alone consists of approximately 50% of the total HCC cases and deaths. In China, chronic hepatitis B virus (HBV) infection is the leading cause for developing HCC. The two challenges in prevention and control of HCC experienced in China are low rates of HCC screening among the high-risk populations and poor adherence to HBV antiviral therapy. As of this date, there is a dearth of research in surveying high-risk populations with chronic viral hepatitis to evaluate the compliance, knowledge level, and self-identified barriers to recommended HCC screening and antiviral medication treatment. In addition to its high incidence and mortality rates in China, HCC is also a major disease burden in the U.S., where HCC is currently the fastest growing cause of cancer-related death. As HCC often leads to poor survival, it is critical to initiate early treatment. Currently, there are no established guidelines to define the optimal time interval from diagnosis to surgery. Knowledge regarding to the impact of HCC treatment delays is solely based on results produced from medical records-based studies conducted in single centers, and findings have been inconsistent. The main objectives of this dissertation are to 1) investigate the practice, knowledge and barriers for HCC screening in high-risk Chinese patients, 2) assess the medication adherence and perceived barriers to oral antiviral therapy for chronic HBV treatment, and 3) utilize the Commission on Cancer’s National Cancer Database to examine the association between surgical treatment delays and long-term survival in HCC patients. In the results of the first objective, we observed that among 352 high-risk patients for HCC, 50.0% had routine HCC screening, 23.3% had irregular screening and 26.7% had incomplete or no screening. The most frequent barriers reported for not receiving screening were not aware that screening for HCC exists (41.5%), no symptoms or discomfort (38.3%), and lack of recommendation from physicians (31.9%). The results of the second objective showed that among 369 patients with chronic HBV, only 16.5% were measured with high adherence while 51.2% had low adherence utilizing the Morisky Medication Adherence Scale. The most common reasons for skipping HBV antiviral medications were that medication(s) are expensive (48.7%), forgetfulness (45.1%), have experienced or worry about potential side effects (19.8%). The results of the third objective showed that using a wait time cutoff at 60 days from the date of HCC diagnosis to definitive surgery, delayed patients demonstrated significantly better 5-year survival for local tumor destruction (29.1% vs. 27.6%) and hepatic resection (44.1% vs. 41.0%). Risk-adjusted model indicated that delayed patients had a 7% decreased risk of death. The findings of these studies may assist healthcare providers and researchers to develop more effective educational programs to improve patients’ awareness, knowledge and perceptions about HCC prevention and control, actively identify the high-risk patients for undergoing HCC screening, and provide better disease management and timely treatment for patients with chronic viral hepatitis to decrease the likelihood of developing HCC. For treating HCC patients, using a national hospital-based cancer registry, our study added new evidence that delay in HCC surgery was associated with a decreased risk of mortality. The finding calls for the need to conduct prospective studies to assess the case prioritization approach and its level of impact in HCC surgical care

BiRA-Net: Bilinear Attention Net for Diabetic Retinopathy Grading

Diabetic retinopathy (DR) is a common retinal disease that leads to blindness. For diagnosis purposes, DR image grading aims to provide automatic DR grade classification, which is not addressed in conventional research methods of binary DR image classification. Small objects in the eye images, like lesions and microaneurysms, are essential to DR grading in medical imaging, but they could easily be influenced by other objects. To address these challenges, we propose a new deep learning architecture, called BiRA-Net, which combines the attention model for feature extraction and bilinear model for fine-grained classification. Furthermore, in considering the distance between different grades of different DR categories, we propose a new loss function, called grading loss, which leads to improved training convergence of the proposed approach. Experimental results are provided to demonstrate the superior performance of the proposed approach.Comment: Accepted at ICIP 201

A Framework for Realistic Simulation of Daily Human Activity

For social robots like Astro which interact with and adapt to the daily movements of users within the home, realistic simulation of human activity is needed for feature development and testing. This paper presents a framework for simulating daily human activity patterns in home environments at scale, supporting manual configurability of different personas or activity patterns, variation of activity timings, and testing on multiple home layouts. We introduce a method for specifying day-to-day variation in schedules and present a bidirectional constraint propagation algorithm for generating schedules from templates. We validate the expressive power of our framework through a use case scenario analysis and demonstrate that our method can be used to generate data closely resembling human behavior from three public datasets and a self-collected dataset. Our contribution supports systematic testing of social robot behaviors at scale, enables procedural generation of synthetic datasets of human movement in different households, and can help minimize bias in training data, leading to more robust and effective robots for home environments.Comment: Accepted and Presented at IEEE International Conference on Robot and Human Communication (ROMAN) 202

Effects of Astragaloside IV on heart failure in rats

<p>Abstract</p> <p>Background</p> <p>Astragaloside IV (ASI) in <it>Radix Astragali </it>is believed to be the active component in treating heart failure. The present study aims to examine the effects of ASI on cardiovascular parameters in long-term heart failure in rats.</p> <p>Methods</p> <p>Using echocardiographic and haemodynamic measurements, we studied the effects of ASI on congestive heart failure (CHF) induced by ligation of the left coronary artery in rats.</p> <p>Results</p> <p>ASI (0.1, 0.3 and 1.0 mg/kg/day) attenuated the decline of fractional shortening (FS). The peak derivatives of the left ventricle (LV) pressure (dp/dt) in ASI-treated groups significantly increased. Both LV internal diameters in diastole (LVIDd) and in systole (LVIDs) decreased significantly after ASI treatment (0.3 and 1.0 mg/kg/day). ASI (1.0 mg/kg/day) attenuated the decrease of LV systolic pressure (LVSP). ASI treatment inhibited compensatory hypertrophy of myocardial cells and lowered the number of apoptotic myocytes.</p> <p>Conclusion</p> <p>ASI improved cardiac functions as measured by cardiovascular parameters.</p

Common Diagnoses among Refugee Populations: Linked Results with Statewide Hospital Discharge Database

Background: According to the U.S. State Department’s Refugee Processing Center and the U.S. Census Bureau, in the fiscal year 2016, among all states in the United States, Nebraska resettled the highest number of refugees per capita. Objectives: The objectives of this study were to determine the most common reasons for refugees utilizing hospital services in Nebraska between January 2011 and September 2015, and to examine whether refugee patients had increased risks for adverse health conditions compared to non-refugee patients. Methods: Statewide linkage was performed between Nebraska Medicaid Program’s immigration data, and 2011–2015 Nebraska hospital discharge data inpatient and outpatient files. The linkage produced 3017, 5460, and 775 cases for emergency department visits, outpatient clinic visits, and inpatient care for the refugee sample, respectively. Findings: Refugee patients were at increased risk for a number of diagnoses or medical conditions, including pregnancy complications, abdominal pain, upper respiratory infections, viral infections, mood disorders, disorders of teeth and jaw, deficiency and anemia, urinary system disorders, headache, nausea and vomiting, limb fractures, spondylosis, essential hypertension, and uncomplicated diabetes mellitus. Conclusions: The findings suggest a greater emphasis on preventive healthcare, especially in areas of maternal health and perinatal outcomes, psychological counseling, screening for infectious diseases, nutrition and healthy eating, and oral health. Additionally, culturally appropriate measures to address prevention, health screening, and treatments should be adopted by health providers who care for refugees

Practice, Knowledge, and Barriers for Screening of Hepatocellular Carcinoma Among High-Risk Chinese Patients

Background: Hepatocellular carcinoma (HCC) is among the leading causes of cancer deaths in China. Considering its poor prognosis when diagnosed late, Chinese guidelines recommend biannual screening for HCC with abdominal ultrasound and serum α-fetoprotein (AFP) test for high-risk populations. Objectives: To investigate the practice, knowledge, and self-perceived barriers for HCC screening among high-risk hospital patients in China. Methods: An interview-based questionnaire was conducted among Chinese patients with chronic hepatitis B and/or chronic hepatitis C infection from outpatient clinics at 2 tertiary medical institutions in Shanghai and Wuhan, China. Findings: Among 352 participating patients, 50.0% had routine screening, 23.3% had irregular screening, and 26.7% had incomplete or no screening. Significant determinants for screening included higher level of education, underlying liver cirrhosis, a family history of HCC, and better knowledge concerning viral hepatitis, HCC, and HCC screening guidelines. Moreover, factors associated with better knowledge were younger age, female gender, urban residency, education level of college or above, annual household income of greater than 150,000 RMB, and longer duration of hepatitis infection. The 3 most common barriers reported for not receiving screening were not aware that screening for HCC exists (41.5%), no symptoms or discomfort (38.3%), and lack of recommendation from physicians (31.9%). Conlusions: Health care professionals and community leaders should actively inform patients regarding the benefits of HCC screening through design of educational programs. Such interventions are expected to increase knowledge about HCC and HCC screening, as well as improve screening adherence and earlier diagnosis